A percutaneous endovascular technique for reducing arteriovenous fistula flow

2019 ◽  
Vol 21 (2) ◽  
pp. 251-255
Author(s):  
Joon Ho Hong
Keyword(s):  
Arteriovenous Fistula ◽  
Stent Graft ◽  
Skin Incision ◽  
Target Area ◽  
Shape Constraint ◽  
Effective Reduction ◽  
Arteriovenous Access ◽  
Endovascular Approach ◽  
Open Surgical Procedure

Reduction of arteriovenous access flow is usually performed by tightening the inflow lumen through an open surgical procedure. A percutaneous endovascular approach can provide a precise and effective reduction of access flow without making a skin incision. After placing a vascular introducer sheath toward the inflow direction of an arteriovenous fistula, a small stent (5 mm diameter × 25 mm length) was deployed in the target area near the anastomosis. A second stent (10 mm × 60 mm) was then deployed inside the first stent, making a corset-shape constraint on the access flow. This newly described endovascular procedure was utilized to reduce the excessive flow of arteriovenous fistula in three patients. Deployment of the constrained stent-graft resulted in reducing the estimated access flow from 1900, 1600, and 1500 mL/min to 1100, 900, and 900 mL/min, respectively. Percutaneous endovascular placement of a constrained stent-graft can narrow the inflow lumen of arteriovenous access to a desired precise diameter of 5 mm and effectively reduce access flow over a long-term period.

Leg Ulcer as a Complication of a Posttraumatic Tibial Arteriovenous Fistula Treated by Endovascular Approach With Stent-Graft Placement

2012 ◽  
Vol 11 (3) ◽  
pp. 147-151 ◽  
Author(s):  
Martín Rabellino ◽  
Sergio Shinzato ◽  
Javier Aragón-Sánchez ◽  
Oscar Peralta ◽  
Ricardo Marenchino ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Stent Graft ◽  
Leg Ulcer ◽  
Graft Placement ◽  
Endovascular Approach

A new endovascular technique for the treatment of dialysis-associated steal syndrome

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 335-337 ◽  
Author(s):  
Enrico Ascher ◽  
Jacob E. Mandel ◽  
Natalie A. Marks ◽  
Anil P. Hingorani
Keyword(s):  
Arteriovenous Fistula ◽  
Stent Graft ◽  
Brachial Artery ◽  
High Risk Patient ◽  
Arterial System ◽  
Dialysis Access ◽  
Endovascular Technique ◽  
Steal Phenomenon ◽  
Endovascular Approach ◽  
Steal Syndrome

Background Dialysis access-associated steal syndrome is a major complication of arteriovenous fistula creation whereby the low-resistance venous conduit shunts arterial inflow through the anastomosis, resulting in clinically significant distal artery insufficiency. Herein, we describe a case of severe steal phenomenon with gangrene of a digit following placement of an arteriovenous fistula that was treated with a novel, entirely endovascular technique. To our knowledge, this was the first totally endovascular approach to dialysis access-associated steal syndrome. Methods Catheterization of the right subclavian, axillary, and brachial arteries was performed. A short 5-Fr sheath was exchanged for a long destination 6-Fr sheath and placed in the proximal brachial artery. An arteriogram showed no stenosis of the arterial system, but did show substantial steal phenomenon with inflow to the arteriovenous fistula, instead of the forearm. We placed a stent graft in the brachial artery across the anastomosis such that the graft covered 3/4 of the length of the opening of the anastomosis. Results Immediately after placement of the stent graft the clinical picture improved dramatically. Patient was followed for 15 months after this procedure until her demise for unrelated causes without ever experiencing dialysis access-associated steal syndrome and with a patent and functional arteriovenous fistula. Conclusion We present a patient with severe dialysis access-associated steal syndrome complicated by third fingertip gangrene, which was successfully treated using a completely endovascular technique. This novel endovascular approach enabled a high-risk patient to avoid open surgery, preserve her limb, and maintain the function of her arteriovenous fistula.

Endovascular Treatment of Arteriovenous Fistula with Pseudoaneurysm at Popliteal Fossa Using a PTFE Stent-graft: A Case Report

2005 ◽  
Vol 52 (2) ◽  
pp. 107
Author(s):  
Jeong Yeol Choi ◽  
Dong Hyun Kim ◽  
Hyung Woo Oh ◽  
Jeong Hwan Jang ◽  
Jae Hee Oh ◽  
...  
Keyword(s):  
Case Report ◽  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Stent Graft ◽  
Popliteal Fossa

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

2020 ◽  
Vol 3 (2) ◽  
pp. 147-150
Author(s):  
Kaczynski RE ◽  
Asaad Y ◽  
Valentin-Capeles N ◽  
Battista J
Keyword(s):  
Arteriovenous Fistula ◽  
Complete Loss ◽  
Dialysis Access ◽  
Loss Of Function ◽  
Access Site ◽  
Surgical Ligation ◽  
Arteriovenous Access ◽  
Vascular Steal ◽  
Steal Syndrome

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

scholarly journals Management of a Mycotic Aneurysm in a Patient with COVID-19: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 620
Author(s):  
Muzammil H. Syed ◽  
Mark Wheatcroft ◽  
Danny Marcuzzi ◽  
Hooman Hennessey ◽  
Mohammad Qadura
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Mycotic Aneurysm ◽  
Neurological Deficits ◽  
Endovascular Stent ◽  
Endovascular Stents ◽  
Abdominal Aortic ◽  
Short Period

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.

scholarly journals The first commercial use of the Valiant Navion stent graft system for endovascular repair of a descending thoracic aortic aneurysm

Vascular ◽  
2020 ◽  
pp. 170853812098112
Author(s):  
Cassra N Arbabi ◽  
Navyash Gupta ◽  
Ali Azizzadeh
Keyword(s):  
Stent Graft ◽  
Standard Of Care ◽  
Aortic Aneurysms ◽  
Descending Thoracic Aortic Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Commercial Use ◽  
Early Results ◽  
Multiple Configuration ◽  
One Year

Objectives Thoracic endovascular aortic repair (TEVAR) is the standard of care for descending thoracic aortic aneurysms (DTAA), and newer generation stent grafts have significant design improvements compared to earlier generation devices. Methods We report the first commercial use of the Medtronic Valiant Navion stent graft for treatment of an 85-year-old woman with a 5.8 cm DTAA and a highly tortuous thoracic aorta. Results A percutaneous TEVAR was performed using a two-piece combination of the Valiant Navion FreeFlo and CoveredSeal stent graft configurations for zones 2–5 coverage. The devices were successfully delievered through highly tortuous anatomy and deployed, excluding the entire length of the aneurysm with precise landing, excellent apposition and no evidence of endoleak. The patient tolerated the procedure well and has had no stent graft-related complications through one-year follow-up. Conclusions Design enhancements such as a lower profile delivery system, better conformability, and a shorter tapered tip are some of the improvements to this third-generation TEVAR device. Coupled with the multiple configuration options available, this gives physicians a better tool to treat thoracic aortic pathologies in patients with challenging anatomy. The early results are encouraging, and evaluation of long-term outcomes will continue.

Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)

2016 ◽  
Vol 9 (4) ◽  
pp. 405-410 ◽  
Author(s):  
Yudhi Adrianto ◽  
Ku Hyun Yang ◽  
Hae-Won Koo ◽  
Wonhyoung Park ◽  
Sung Chul Jung ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Fistula ◽  
Open Surgery ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula ◽  
Posterior Spinal Artery ◽  
Lumbar Level ◽  
Scale Scores ◽  
Complete Obliteration ◽  
Endovascular Approach

Background/objectiveThe concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.MethodsIn 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.ResultsNine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months.ConclusionsThe concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.

Endovascular Stent-Graft Repair of Major Abdominal Arteriovenous Fistula:

2009 ◽  
Vol 16 (4) ◽  
pp. 514-523 ◽  
Author(s):  
George A. Antoniou ◽  
Stylianos Koutsias ◽  
Christos Karathanos ◽  
Giorgos S. Sfyroeras ◽  
Georgios Vretzakis ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Stent Graft ◽  
Endovascular Stent ◽  
Endovascular Stent Graft ◽  
Stent Graft Repair ◽  
Endovascular Stent Graft Repair

scholarly journals Best Vascular Access in the Elderly: Time for Innovation?

2018 ◽  
Vol 47 (1-3) ◽  
pp. 236-239 ◽  
Author(s):  
Arif Asif ◽  
Mohamed M. Bakr ◽  
Michael Levitt ◽  
Tushar Vachharajani
Keyword(s):  
Arteriovenous Fistula ◽  
Ulnar Artery ◽  
The Elderly ◽  
Dialysis Access ◽  
Failure Rates ◽  
Early Failure ◽  
Upper Arm ◽  
Arteriovenous Access ◽  
Surgical Manipulation ◽  
Innovative Techniques

Background: Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. Summary: While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates. Two percutaneous innovative techniques that successfully establish fistulas at the upper arm using proximal radial/ulnar ­artery as the inflow have been recently introduced. These procedures have been successfully performed in the elderly. Importantly, these techniques bypass the open surgical exploration and as such avoid the surgical manipulation of the juxta-anastomotic region (a common cause for the development of juxta-anastomotic stenosis and early fistula failure). Key Message: This article discusses the arteriovenous fistula creation in the elderly, highlights the factors necessary for successful fistula creation, and describes the 2 innovative techniques that can be used to provide a robust platform for successful fistula creation in this population.

Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-Grade Cavernous Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E475-E482 ◽  
Author(s):  
Michael C. Hurley ◽  
Rudy J. Rahme ◽  
Andrew J. Fishman ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
High Grade ◽  
Direct Puncture ◽  
Superficial Middle Cerebral Vein ◽  
Endovascular Approach ◽  
Cortical Venous Drainage

Abstract BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

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